Injury
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Comparative Study
Identifying patients at risk for high-grade intra-abdominal hypertension following trauma laparotomy.
Abdominal Compartment Syndrome (ACS) is an uncommon but deleterious complication after trauma laparotomy. Early recognition of patients at risk of developing ACS is crucial for their outcome. The aim of this study was to compare the characteristics of patients who developed high-grade intra-abdominal hypertension (IAH) (i.e., grade III or IV; intra-abdominal pressure, IAP >20 mm Hg) following an injury-related laparotomy versus those who did not (i.e., IAP ≤20 mm Hg). ⋯ This is a level III retrospective study.
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Studies such on alcohol and injuries have defined alcohol-related injury as an injury with a positive self-report of alcohol consumption in the 6h prior to the event. However, there is very limited data on the pattern of alcohol use over time of day and day of week among the general population. The aim of this study is to estimate the rate of alcohol use by time of day, and day of week for the U.S. general adult (≥ 18 years) population. ⋯ The general US population, especially young adults are exposed to alcohol and its acute effects at a much higher level during the night, and this in-turn increases the risk of alcohol-related injuries during that time.
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Multicenter Study
Clinical gestalt and the prediction of massive transfusion after trauma.
Early recognition and treatment of trauma patients requiring massive transfusion (MT) has been shown to reduce mortality. While many risk factors predicting MT have been demonstrated, there is no universally accepted method or algorithm to identify these patients. We hypothesised that even among experienced trauma surgeons, the clinical gestalt of identifying patients who will require MT is unreliable. ⋯ Data from this large multicenter trial demonstrates that predicting the need for MT continues to be a challenge. Because of the increased mortality associated with delayed therapy, a more reliable algorithm is needed to identify and treat these severely injured patients earlier.
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Free-text fields in injury surveillance databases can provide detailed information beyond routinely coded data. Additional data, such as exposures and covariates can be identified from narrative text and used to conduct case-control studies. ⋯ This exploratory analysis illustrates the potential utility of relatively simple text-search algorithms to identify additional variables in surveillance data. Limitations of this study include possible selection bias and the inability to identify individuals with multiple injuries. A similar approach can be applied to study other injuries, conditions, risks, or protective factors. This approach may serve as an efficient method to extend the utility of injury surveillance data to conduct epidemiological research.
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Evidence-based guidelines for the care of severe traumatic brain injury have been available from the Brain Trauma Foundation (BTF) since 1995. A total of 15 recommendations compose the current guidelines. Although each individual guideline has been validated in isolation, to date, little research has examined the guidelines in composite. We examined the relationship between compliance with the BTF severe TBI guidelines and mortality. ⋯ Our data indicate that full compliance with all 15 severe TBI guidelines is difficult to achieve and may not be necessary to optimally care for patients.